If you’ve been alarmed by a recent media reports about a study highlighting the risks to babies conceived using reproductive therapies then here’s the good news: it’s not necessarily the treatments that are causing the problems. In fact, the most likely cause of the (very) slightly poorer outcomes among these babies are the underlying fertility issues that drive couples to seek treatment in the first place.

Where the risky figures came from

More than 320,000 South Australian births (between 1986 to 2002) were analysed at University of Adelaide’s Robinson Institute, including more than 4,300 births from various forms of assisted conception (including IVF.) The findings revealed assisted conception babies were more than twice as likely to be premature, almost three times as likely to have a very low birth weight and twice as likely to die within the first 28 days of their lives.

Dr Mark Bowman from Genea (formerly Sydney IVF) says that parents should remember that those figures are still very low. “Half as uncommon is still uncommon,” he said. For example, looking at the figures above for neonatal deaths you’re still talking about less than one baby in 100 affected.

Is clomiphene citrate a contributor?

The report suggested that commonly used fertility drug might be partly to blame. Babies of women who had been diagnosed as infertile, but later went on to conceive were the most at risk. “We know this group of women tend to use a drug called clomiphene citrate for infertility. It’s a very common, very cheap drug, but its adverse consequences have not been terribly well studied. We are now extremely keen to investigate this,” said Michael Davies.

But Dr Bowman disagrees. “The study found that people with a history of infertility who didn’t do treatments like IVF and still got pregnant had the same level of adverse outcomes. This suggests that people who need IVF might be bringing problems in because of their infertility.”

So there’s no need to panic

Medical director of IVF Australia, Associate Professor Peter Illingworth when interviewed about the new study, said, “It does show that pregnancies associated with IVF are slightly riskier than pregnancies that take place naturally. What is not clear is why that should be the case. The study also shows that other children conceived naturally by the same partners also have a high risk of problems in their pregnancy.”

The University of Adelaide’s Michael Davies, who led the study, agrees. He says, “There is in all likelihood a contribution from both the treatment and patient factors. We have very unfriendly work practices that mean families defer child-bearing until women are relatively old, and that is tragic.”

Dr Mark Bowman agrees that there is a slightly higher rate of problems when babies are conceived from IVF, but emphasises that the techniques used are probably not to blame.

“Past processes around IVF might have added to the background risk, the most common one being multiple embryo transfer. By simply moving to single embryo transfer (as most clinics in Australia have done) the rate of stillbirth, premature birth, miscarriage, etc, have been significantly reduced. So what we’ve seen over time has been progressive improvements in outcomes because of changes, but what we can’t change is the contribution from couples,” he said.

He goes on to give the example of men with very low sperm count. “In most cases, there’s a genetic reason for their low sperm count. Without doing ICSI (where a single sperm is injected into a mature egg) the couple would never have a baby. By doing the treatment, the problematic genes that contribute to the low sperm count are passed along to the next generation. If that leads to poorer outcomes you can’t blame the ICSI because it’s about the couple, not the ICSI.”

Pre-existing conditions and treatments play a part

Researchers are still trying to discover how assisted conception treatments contribute to poor outcomes and the role pre-existing conditions in parents might play.

While these figures are worrying, researchers are continuing to gather information to ensure that IVF and other assisted conception babies and their mums have the very best chance at optimum health. Let’s not forget those 5 million plus happy, healthy IVF babies. That’s something to celebrate.

Dr Bowman likens the situation to the risks of air travel. “Nobody gets on a plane to Brisbane and says, ‘Now listen, is there absolutely no risk of me crashing if I get on this plane?” because of course there is, even though it’s probably very slight. The truth is there might be less risk if you walk instead of fly, but the danger is, you might not get there at all.”